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BackgroundProximal humeral fractures (PHFs) are the third most commonly occurring fractures in elderly patients. Most of these fractures can be treated with conservative methods, but the optimal surgical treatment strategy for unstable fractures in elderly patients remains controversial. This study aimed to compare the radiological and clinical outcomes between locking compression plate (LCP) fixation and LCP fixation with fibular allograft implantation for the treatment of comminuted PHFs.MethodsWe retrospectively reviewed 60 patients (mean age, 72.75 years) with closed 3- or 4-part fractures, and a minimum of 2 years of follow-up. Fracture reduction was quantitatively determined by humeral head height (HHH) and neck-shaft angle (NSA). The clinical outcome was evaluated by Constant-Murley score (CMS) and American Shoulder and Elbow Surgeons (ASES) score.ResultThe average radiological changes were higher in the LCP group than in the locking plate with fibular allograft group (HHH of 4.16 mm vs 1.18 mm [p < 0.001] and NSA of 9.94° versus 3.12° [p < 0.001]) . The final average outcome scores were lower in the LCP group than in the FA group (CMS of 73.00 vs 78.96 [p = 0.024] and ASES score of 72.80 vs 78.64 [p = 0.022]). The FA group showed better forward elevation (p = 0.010) and abduction (p = 0.002); however, no significant differences were observed for shoulder external rotation or internal rotation. The number of complications was higher in the LCP group (28.57%) than in the FA group (1.2%) (p < 0.001).ConclusionFor comminuted PHFs in elderly patients, LCP fixation combined with a fibular allograft is reasonable option to ensure satisfactory radiological and clinical outcomes.Trial registrationZDYJLY(2018)New-9. Name of registry: IEC for clinical Research of Zhongda Hospital, Affiliated to Southeast University. Date of registration: 2018-05-17.

Abstract. Quantifying the effects of forest changes on hydrology in large watersheds is important for designing forest or land management and adaptation strategies for watershed ecosystem sustainability. Minjiang River watershed, located in the upper reach of the Yangtze River basin, plays a strategic role in the environmental protection and economic and social well-being for both the watershed and the entire Yangtze River basin. The watershed lies in the transition zone from Sichuan Basin to Qinghai-Tibet Plateau with a size of 24 000 km 2 . Due to its strategic significance, severe historic deforestation and high sensitivity to climate change, the watershed has long been recognized as one of the highest priority watersheds in China for scientific research and resource management. The purpose of this review paper is to provide a state-of-the-art summary on what we have learned from several recently completed research programs (one of them known as "973 of the China National Major Fundamental Science" from 2002 to 2008). This summary paper focused on how land cover or forest change affected hydrology at both forest stand and watershed scales in this large watershed. Inclusion of two different spatial scales is useful, because the results from a small spatial scale (e.g. forest stand level) can help interpret the findings on a large spatial scale. Our review suggests that historic forest harvesting or land cover change has caused significant water yield increase due to reduction of forest canopy interception and evapotranspiration caused by removal of forest vegetation on both spatial scales. The impact magnitude caused by forest harvesting indicates that the hydrological effects of forest or land cover changes can be as important as those caused by climate change, while the opposite impact directions suggest their offsetting effects on water yield in the Minjiang River watershed. In addition, different types of forests have different magnitudes of evapotranspiration (ET), with the lowest in old-growth natural coniferous forests (Abies faxoniana Rehd. et Wils.) and the highest in coniferous plantations (e.g. Picea asperata Mast.) among major forest types in the study watershed. This suggests that selection of different types of forests can have an important role in ET and consequently water yield. Our synthesis indicates that future reforestation and climate change would likely produce the hydrological effects in the same direction and thus place double the pressure on water resource as both key drivers may lead to water yield reduction. The findings can support designing management strategies for protection of watershed ecological functions in the context of future land cover and climate changes.